Q & A – Kincardine Hospital CT Project

The Edge Plus is newest CT scanner produced by Siemens with the latest CT technology available, that produces images with high speed, low dose radiation, that will meet all the needs of the Kincardine community

There is no clinical difference in the quality of the general CT scanning capabilities of the Edge Plus versus the Drive.

The internal components of the Edge Plus are identical to the Drive – both use the same detectors, same tubes, same dose, same software platform, same slice thickness, producing identical image quality, with the exception that the Drive has two tubes (faster scan in some circumstances, not impacting the majority of scans).

The Edge Plus will eliminate the need for patients needing to travel to Walkerton or other sites for CT scans. The comprehensive technology of this machine will more than meet the needs of the Kincardine community.

The Edge Plus is the newest Siemens CT technology available (Health Canada approved in 2020). This technology is currently in use in 53 sites in the United States.

The Edge Plus can perform dual energy scanning through the use of twin Beam technology.

The lower cost of ownership of this model will free up resources to support other programs and services at the Kincardine hospital, such as the upcoming hospital redevelopment project, and other expensive diagnostic equipment that will require replacement in the coming years (mammography, x-ray).

The feedback and advice from SBGHC’s Chief Radiologist, who reads the images produced by the scanner and provides reports to physicians, supports this decision.

The feedback and advice from Cardiologist Dr. Gerard Shoemaker who, with his colleagues from London, has seen over 2,000 cardiac patients in Kincardine.

The Kincardine and Community Health Care Foundation’s fundraising campaign for the CT scanner has not yet begun – so donations from the community have not been collected that were intended to be used specifically for the Drive CT scanner.  The Foundation has received four corporate and business donations that have been identified to be put towards the CT scanner, regardless of the model selected.

The CT scanner project at the Kincardine hospital has been made possible through the support of the Kincardine and Community Health Care Foundation, who have committed to fund the cost of the CT scanner, some of the service contract costs, and additional costs for building development, totaling $2.7M. This includes a $1M donation from Bruce Power committed to support improvements to the Kincardine hospital Emergency Department.

Now that the model selection has been finalized, plans for launching the fundraising campaign are underway.

The Government of Ontario has committed to fund $1.4M for the building addition which will house the new CT.

It should be emphasized that the funds raised by the Kincardine and Community Health Care Foundation support the purchase of equipment and renovations specifically for the Kincardine site of South Bruce Grey Health Centre.

The difference in cost between the Edge Plus and the Drive is money that the Kincardine Foundation will not have to fundraise in the community.

In addition, SBGHC has identified $2M in capital requirements for the Kincardine hospital that rely on the Kincardine Foundation to support. The list includes much needed equipment from all departments, with items ranging in cost from $1,000 to over $900,000.  Some examples include a new Mammography Machine ($963K), Ultrasound Machine ($224K), Bone Mineral Density Machine ($136K), Cardiac Monitor Upgrade ($111K), Endoscopy Videoscopes ($253K), among many other items.

SBGHC is also proceeding through the Ministry of Health’s Capital Redevelopment Process to redevelop the entire Kincardine hospital.  Phase 1 of the project includes a significant expansion of the Emergency Department, Diagnostic Imaging Department, Laboratory and lobby area, with a total cost of approximately $61M.  With all capital projects, local communities are required to fund 10% of the costs, plus the cost of furnishings and equipment.  To complete Phase 1 of the hospital redevelopment, the local community will be required to raise $9.7M.  Phase 2 will include the inpatient unit and operating room, totaling approximately $113M (with a local share of $18M).

It should be emphasized that the funds raised by the Kincardine and Community Health Care Foundation support the purchase of equipment and renovations specifically for the Kincardine site of South Bruce Grey Health Centre.

SBGHC’s Board and Leadership Team share the same goal as the physician group – to ensure that an appropriate model of CT scanner is selected that will meet the needs of the Kincardine community now and into the future.

In addition to SBGHC leadership meeting with the Kincardine physician group at its monthly Medical Advisory Committee (MAC) meetings, the SBGHC Board held two meetings specifically for the Kincardine physicians.  The first meeting was held on November 23^rd, 2020 before the Board’s decision where a 68 page report on the CT project was provided to the physicians.  A second dedicated meeting was held on January 19^th, 2021 where the Board convened to hear the questions and concerns of the physician group following the Board’s decision.

The input from the group of Kincardine physicians was carefully considered by our Board and Leadership Team, along with input from other key stakeholder groups, including our Chief Radiologist, Dr. Douglas Mowbray, and Dr. Donald Taves, London X-Ray Associates Radiologist.

It is important to note that CT images are read by a specialty physician called a Radiologist.  The job of a Radiologist is to read these images who then provides a report to the Family or Emergency Department physician.  Dr. Mowbray was consulted throughout the model selection process, and his input was also considered carefully by the SBGHC Board in its decision.

In addition to the guidance from our Radiologists, Cardiologist Dr. Gerard Shoemaker provided his perspective – Dr. Shoemaker visits the Kincardine hospital from London regularly to see patients.

“I would like to make it clear that the Cardiologists that are currently coming up to Kincardine to do clinics have no vested interest nor are they supportive of either model of CT scanner that is being considered.  The decision of which CT scanner is best for the community should be made independent from the Cardiology Program and its physicians.

I can give you my point of view as a Cardiologist who has been doing Cardiology Clinics in Kincardine for the past 4 years as well as my two colleagues who have been doing clinics with me in Kincardine for 2 years. We have had approximately 2,000 patient visits in the clinic over the past 4 years.  Over the past 4 years, we have cumulatively ordered between 5-10 CT scans of the heart. That’s far less than 1% of the patients we see. We also do not anticipate this number to change significantly in the future as cardiac CTs are not a study we routinely order in our practice nor are they the standard of care for common cardiac presentations.  It would be nice to be able to reassure the people of Kincardine that they are receiving the same quality of Cardiology care as people in London or anywhere else in Southwestern Ontario.”

– Dr. Gerard Shoemaker, Cardiologist

In 2018 when the CT scanner at SBGHC’s Walkerton site was replaced, the Edge Plus machine was not available.  The only options from Siemens (successful RFP bidder) at the time were the Edge (not the Edge Plus) and the Drive.

Between the two options considered (Edge and Drive), the Drive was selected as it was the newest low-dose technology available from Siemens. The same technology is now available in the Edge Plus.

No.  The Edge Plus will eliminate the need for patients needing to travel to Walkerton or other sites for CT scans.  The comprehensive technology of this machine will more than meet the needs of the Kincardine community.

The purchasing agreement with Siemens was negotiated in December 2017 as part of the open RFP process for the replacement of the CT scanner at the Walkerton site in 2018.  There is also an option for a 2-year extension.

A life cycle cost analysis was performed taking into account the initial expenditure, the ongoing maintenance and operational costs, and the operational performance of the machine.   The organization annually reviews and prioritizes the capital requirements for the next 5 years, including the cost to bring the asset into service and the salvage value of end of life equipment.

SBGHC has an existing five-year purchasing agreement with Siemens that was negotiated through an open Request for Proposal (RFP) process. At that time, all vendors were provided equal opportunity to present their products, service and pricing (ie. Canon, Philips, GE). Standardizing a vendor benefits our staff and physicians by:

• • Providing ease of program development and ongoing support
  • Ease of cross site support for radiologists and staff
  • Sharing the CT software server
  • Standardizing common protocols

The internal components (tubes, detectors) of the Edge Plus are the same internal components of the Drive, and are available. Service Contracts on both machines have uptime guarantees that will be met by Siemens.

Staff support for CT exams is more complex than just the scan time, and would not vary based on the model of the machine. For example, staff consult with patients prior to the exam to review medical history and consent.  In some cases, patients are required to drink oral contrast 1 hour before the exam.  For the majority of exams, an IV is started.  While the patient is on the table, preliminary views are completed to set up the protocol.  The ‘scan time’ on either machine is calculated in seconds.  For the Drive, max scan speed is 458mm/s and for the Edge Plus 230mm/s.  Changing the exam length by seconds does not change efficiency or throughput.

No. All Emergency patients will be scanned in Kincardine on the Edge Plus.

If the secondary tube on the Drive malfunctions (main tube remains functioning), the system can still function.  However, the scanner would still need to be taken out of service to replace the malfunctioned tube.

The Kincardine and Community Health Care Foundation’s fundraising campaign for the CT scanner has not yet begun – so donations from the community have not been collected that were intended to be used specifically for the Drive CT scanner.  The Foundation has received four corporate and business donations that have been identified to be put towards the CT scanner, regardless of the model selected.

The Edge Plus CT scanner is the latest CT technology released from Siemens, and new to Canada, however, there are 53 Edge Plus CT scanners currently in use in the US. The internal components of the Edge Plus are identical to the internal components of the Drive, with the only difference being that it operates with one tube and generator instead of two.

No, the CT scanner for the Kincardine hospital has not been ordered yet. However, SBGHC’s Board of Directors has made the decision regarding the model, and as part of the planning process for the CT suite addition, detailed electrical and support services design work is well underway to facilitate the installation of the Edge Plus.

The Edge Plus is not an upgraded version of the Edge, which is an older technology (released in 2010). The Edge Plus is the newest CT technology available from Siemens, and far outperforms most other options on the market. The internal components of the Edge Plus are identical to the Drive – both use the same detectors and tubes, same dose, same software platform, same slice thickness, producing identical image quality, with the exception that the Drive has two tubes and generators.

The care of patients at the Kincardine hospital will not be compromised. In fact, care of patients will be significantly improved by having this service available in Kincardine, and it is irresponsible to suggest that the selection of the Edge Plus could impact patient safety and the ability to save lives.